Mobbs et al (2015) noted that degenerative disc and facet joint disease of the lumbar spine is common in the aging population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicating symptoms, reduced mobility and poor quality of life (QOL). Surgical interbody fusion of degenerative levels is a therapeutic option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and ALIF. The indications may include: discogenic/facetogenic low back pain (LBP), neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the para-spinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach-related abdominal and vascular complications. Furthermore, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. These investigators comprehensively reviewed the available literature and evidence for different LIF techniques. They proposed a set of recommendations and guidelines for the indications for interbody fusion options. In addition, these researchers provided a description of each approach, and showed the potential benefits and disadvantages of each technique with reference to indication and spine level performed.
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